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Empathy and Sympathy: Voices from Literature

      Empathy and sympathy fit perfectly with medical practice, but reflection and research demonstrate a lack of consistency in the use and definition of empathy as well as the multitudinous definitions of sympathy. A short excursion into contemporary literary works reveals diverse opinions about the clinical usefulness of empathy and sympathy.
      For Mercy has a human heart,Pity a human face,And Love, the human form divine,And Peace the human dress.William Blake Empathy and sympathy: at first glance, the 2 concepts fit perfectly with medical practice. Clearly, these are emotions competent clinicians must know how to display; they are a part of good bedside manner. However, reflection and research demonstrate a “lack of consistency” in the use and definition of empathy as well as the multitudinous definitions of sympathy.
      • Eisenberg N.
      • Strayer J.
      A short excursion into some contemporary works of fiction reveals a diversity of opinion about the clinical value of empathy and sympathy.
      To begin discussing the 2 ideas requires a definition. The Oxford English Dictionary Online defines empathy as “the power of projecting one’s personality into (and so fully comprehending) the object of contemplation.” In a cited comment by R.L. Katz from 1963, empathy is linked with sympathy: “It is true that in sympathy and empathy we permit our feelings for others to become involved.”

      Oxford English Dictionary Online. Empathy. http://www.oed.com. Accessed December 13, 2005.

      A recent handbook by a physician embeds empathy in the clinical setting: “Empathy is the ability to understand the patient’s experiences and feelings accurately; it also includes demonstrating that understanding to the patient.”
      • Coulehan J.L.
      • Block M.L.
      All these definitions are, of course, open to interpretation; hence, the uncertainty about what empathy really means.
      Studying the Oxford English Dictionary Online’s definitions of sympathy severely complicates our project, for sympathy crops up too frequently in literature from the 16th century to the present. Picking a definition of sympathy suitable to clinical practice, we read, “the quality or state of being affected by the condition of another with a feeling similar or corresponding to that of the other . . . fellow-feeling.”

      Oxford English Dictionary Online. Sympathy. http://www.oed.com. Accessed December 13, 2005.

      Not only good and ethical medical practitioners but everyone ought to show sympathy and fellow-feeling; on this we can agree.
      The American poet and physician Rafael Campo communicated his own empathic reaction to a patient’s suffering in his poem “El Curandero.” He created a first-person physician narrator who returns home after a long, hard day at the hospital, takes a soothing bath, and engages in a dialogue with his patron saint, Rafael, about the patients he has seen on this day. A little girl on a tricycle had her chest crushed, presumably by a car. The speaker says, I saw pain—Primitive, I could see it, through her splitChest, in her crushed ribs—white-hot.The empathic physician enters his patient’s body, sees her pain, and physically feels it, “white-hot.” Telling his anguish alleviates it: Now,I can stop. He has listened, he is silent.
      • Campo R.
      El Curandero.
      Campo caught in words the cost to the physician of empathy: it makes him suffer hard.
      Another modern American poet, not a doctor himself but familiar with the suffering of patients with AIDS, weighed in against empathy. Thom Gunn’s poem “Save the Word,” addressed to medical students, derisively addresses these future doctors: Save the wordEmpathy, sweetheart,For your freshman essays.True empathy is just not humanly possible: Don’t try it. OnlyJesus could do it and heProbably didn’t exist.Instead, he says, try active sympathy; this will connect you with others when you share yourself with them: … split a cloak with a beggar,slip a pillow under the head of the arrested man, hold tightthe snag-toothed hustler with red hair.
      • Gunn T.
      Save the word.
      Thom Gunn’s bitter poem cuts to the essence of fellow-feeling: it counts only if you use it with society’s outcasts.
      Let us listen to 1 last voice from the literature of sympathy: British investigator Virginia Woolf, a patient herself, wrote a famous essay titled “On Being Ill.” In it, she discussed the nature of sympathy and emphasized the unattainable goal of true sympathy. She argued that our needs and fears differ; therefore, we cannot penetrate each others’ minds: “About sympathy for example; we can do without it . . . . We do not know our own souls, let alone the souls of others. Human beings do not go hand in hand the whole stretch of the way.” Woolf exhibited the same skepticism about our capacity for fellow-feeling as Thom Gunn.
      • Gunn T.
      Save the word.
      We can try to be sympathetic toward another, but we never will quite understand what the other feels. She explained, “There is a virgin forest, tangled, pathless, in each; a snow field where even the print of a bird’s feet is unknown. Here we go alone, and like it better so. Always to have sympathy, always to be accompanied, always to be understood would be intolerable.”
      • Woolf V.
      Illness.
      This patient prefers to suffer in private. Gratuitous offers of sympathy carry no comfort for her. She wants respect.
      Despite our uncertainty about the nature of empathy and sympathy, we can probably all agree on the desirability of doctors’ learning and showing these emotions during encounters with patients. Demonstrating such feelings can be especially useful in situations such as giving bad news.
      • Coulehan J.
      • Block M.L.
      In addition, recent research
      • Larson E.B.
      • Yao X.
      Clinical empathy as emotional labor in the patient-physician relationship.
      has shown that empathetic behavior toward patients can be practiced and learned as “emotional labor” with personal and healing benefit to caregivers and patients. To quote this important study, “physicians who display a warm, friendly, and reassuring manner with their patients are more effective.”
      • Larson E.B.
      • Yao X.
      Clinical empathy as emotional labor in the patient-physician relationship.
      However we may define them, there is a place for empathy and sympathy in modern medicine.

      Acknowledgment

      Thanks to Joseph S. Alpert, MD, for his helpful review of this editorial.

      References

        • Eisenberg N.
        • Strayer J.
        Empathy and Its Development. Cambridge University Press, Cambridge, UK1987: 5-6
      1. Oxford English Dictionary Online. Empathy. http://www.oed.com. Accessed December 13, 2005.

        • Coulehan J.L.
        • Block M.L.
        The Medical Interview Mastering Skills for Clinical Practice. F.A. Davis, Philadelphia, PA1999: 23
      2. Oxford English Dictionary Online. Sympathy. http://www.oed.com. Accessed December 13, 2005.

        • Campo R.
        El Curandero.
        in: Reynolds R. Stone J. Nixon L.L.C. Wear D. On Doctoring Stories, Poems, Essays. Simon & Schuster, New York, NY2001: 398-399
        • Gunn T.
        Save the word.
        in: Bamforth I. The Body in the Library. Verso, London, UK2003: 380-381
        • Woolf V.
        Illness.
        in: Bamforth I. The Body in the Library. Verso, London, UK2003: 380-381
        • Coulehan J.
        • Block M.L.
        The Medical Interview Mastering Skills for Clinical Practice. F.A. Davis, Philadelphia, PA1999: 283
        • Larson E.B.
        • Yao X.
        Clinical empathy as emotional labor in the patient-physician relationship.
        JAMA. 2005; 293: 1100-1106